S.Harrison Consulting Interest Form

Welcome! To better understand your situation and how I can help, please fill out the following questionnaire:

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Email *
Your Name 
Phone
State of Residence 
County of Residence 
What is your relationship to the care recipient? 
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Care Recipient's Age
Briefly describe the care recipient's disability and/or care needs.
How many employees does the care recipient currently employ?
Do these employees have a written job description? 
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How do you currently schedule employees?
Are you interested in hiring new employees?
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How many employees are you planning to recruit? 
Are you looking for assistance with: 
Please describe the specific challenges that lead you to seek support. 
How quickly do you need these challenges resolved? 
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Do you currently have a Mediciad waiver? 
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If you have a Medicaid waiver, which one? 
Is there anything else you would like to share that might help me understand your needs? 
Do you have any accommodations or other supports to particpate in a video call? 
How did you learn about Samantha's Care Consulting services? 
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